I have worked at Pelican Bay State Prison (PBSP), California Department of Corrections and rehabilitation (CDCr) from 1999 to September of 2006 as a “physician and surgeon” including from July 2000 to august 2002 as “chief physician and surgeon”. My work assignments during that time have included months of time as primary care provider in the security housing unit (SHU), where the long term solitary confinement patients are located. As a medical supervisor, I was also involved in the formulation of healthcare policy at PBSP. I am very familiar with the serious medical issues involved with the long term and short term care of these SHU patients in solitary confinement that are both very deleterious to human health and not very visible to people who are not insiders and familiar with this environment at PBSP. Many of these issues have not penetrated the ongoing public discussion of the ongoing and created health care consequences of solitary confinement in the SHU at PBSP

I should also mention that since leaving PBSP, I have also served as a material witness and expert medical witness in legal actions brought by my former patients in the PBSP SHU in medical habeas corpus cases adjudicated by the local courts. I have also served as such a subpoenaed witness in cases that my former patients bring into federal courts for civil rights violations under the eighth amendment as intentional “cruel and unusual punishment”.

In addition, I have been a court appointed expert witness (non-medical) on behalf of PBSP SHU inmates in “gang validation” cases in which PBSP was trying to sustain and further validate these patients’ SHU terms. So, I have experience and understanding independent of my medical experience at PBSP of the process and consequences of the legal cauldron of establishing solitary confinement terms at PBSP specifically. Therefore, my statements here come from a variety of experiences that have put me into a position where my views come from more than one experiential point of view on this issue.

First, let me state that solitary confinement itself, from what I have witnessed, is torture. The prison system embellishes and enhances that torture. Long term solitary confinement should be attenuated then abolished in the jails and prisons of the United States of America.

Let me start with an actual situation that forced me to begin to confront this issue while I was still in the employ of PBSP. I treated a patient from the SHU in the urgent treatment area of PBSP infirmary. That patient, in addition to his physical medical complaints was extremely emotional, anxious and agitated. He told me that his daughter was sick and hospitalized in critical care. He did not have access to the mail informing him of that situation until 3 weeks after that mail had been delivered to the prison. I had heard other complaints from SHU inmates about access to mail, but this was very dramatic and brought the point home. I began to wonder then and now, how does depriving solitary confinement patients of mail and family communication protect the public safety? Can PBSP/CDCr demonstrate with data that solitary confinement and its attendant focused restrictions, decrease gang activity within the prison and on the streets, considering the human costs of such confinement?

PBSP was created as the flagship solitary confinement institution in California and probably in the country. During that time, it is my understanding that prison gangs in the CDCr have strengthened and expanded to include on the street prison gang related criminal activity. The point of this type of confinement, I thought was to stop this type of activity. The PBSP and CDCr need to demonstrate with numbers what the effective gain is to the issue of public safety by treating human beings this way. These are recurrent questions that need to be examined in detail.

PBSP is a very spiritually toxic environment, but there are very capable intelligent custody officers with integrity there that I worked with over time that are still employed there. This is however an environment that can enhance non-transparent wrong doing. I call it an “enhancing environment” or more appropriately, a “negatively enhancing environment”. There is continual development of difficult to negotiate situations for those who want to do good and want to do the right thing in this dramatic crucible.

The same is true for the medical side of the prison except that the medical leadership has been demonstrably defective over time per my experience. As medical practitioners, society gives us the right and the privilege to invade peoples’ most intimate physical, emotional and spiritual spaces in an effort to heal them.

In the book: Oath betrayed: torture, medical complicity and the war on terror, Dr. Steven Miles, MD states:

“Clinicians who work in prisons are the frontline human rights workers in prison”

I can demonstrate, from my medical habeas corpus cases and from the federal cases that I have participated in as a material witness that the current medical managers at PBSP are “medical turncoats” and embellish the torture of solitary confinement.

The first purely medical issue that i want to reveal has to do with the lack of appropriate health care specifically for patients in long term solitary confinement. During most of my time at PBSP, as a primary care provider, I reviewed the mental health notes in the medical records for my patients per visit. That is just the practice of good medicine, but this was important because many of my patients were on atypical antipsychotics, anti-depressesants, and mood altering medications that had medical side-effects. Some of these drugs were newly introduced to patient populations and needed to be actively and intelligently followed as various patient populations were being exposed to them. I do not ever remember seeing a note or a diagnosis of seasonal affective disorder (SAD) in long term solitary confinement patients or in patients in other parts of the prison. I have gone back and had recent numerous discussions with current and former mental health practitioners and staff with whom I worked at PBSP, to try to understand why this diagnosis, that occurs in people who are deprived of natural photons, is not discussed or diagnosed in this vulnerable population. I do not have a clear answer. PBSP currently has very competent mental health practitioners. They should be given a chance to explain this apparent historical mystery.

There is evidence that vitamin d deficiency alone affects cognition, depression, anxiety and a multiplicity of medical problems. The relationship between sad and vitamin d deficiency is still being worked out, but we do know that both conditions respond to increased exposure to natural light. In the case of vitamin d deficiency, it has been demonstrated that light exposure alone is not adequate to reverse the deficiency. Diet can help, but in the setting of the PBSP SHU there are reasons why diet supplementation alone may not work.

In one of the specific medical habeas corpus cases out of the PBSP SHU in which I participated, the judge found that my former patient was not being given food that was fresh enough and nutrient rich enough to keep him healthy. So, the food that the patients are getting in the solitary confinement environment may not be nutritionally adequate to treat vitamin D deficiency.

Evidence demonstrates, particularly that African-American males in the northern hemisphere are at greater risk for vitamin d deficiency. They have low measurable levels of vitamin d compared to non-whites. I am African-American and started taking vitamin d supplements in January of this year in the form of vitamin D3 at a dose 4,000 iu per day. In May, my provider checked my blood level of vitamin d and surprisingly, i am deficient as of that measurement after intentional supplementation. This is a worrisome anecdote for PBSP SHU patients.

Vitamin D is added to milk, but let us remember that African- Americans have a very high rate of lactase deficiency and cannot digest milk without dietary aids. (I also have lactase deficiency.) Again, one of the medical habeas corpus cases in which I participated out of the SHU at PBSP involved a patient who transferred into PBSP from another facility where he had been prescribed lactase to help him drink milk and digest dairy products. This lactase supplement was discontinued by medical management at PBSP upon his arrival. For this solitary confinement patient, maybe the one viable source of dietary vitamin D had been taken away from him. He had to take legal action to get it back.

So, patients in long term isolation are subject to both sad and separately, vitamin D deficiency because of their sequestration from natural sunlight. There is seemingly no forward plan that I am aware of, to address either one of these specific entities that are encouraged by the solitary confinement conditions. The medical side of PBSP has some very competent practitioners, but as you can see from the above episodes, they cannot always overcome the overbearing, indifferent medical management that they serve under to better affect adequate patient care. The reasons why the specific issue of long term solitary confinement patients that are vulnerable to vitamin d deficiency are not being surveilled and treated in the setting of the PBSP SHU is consistent with the non-forward manner in which the issues of the hepatitis c infection crisis, and the MRSA infection crisis were handled while I worked at PBSP. Additional reasons for these inexcusable medical “oversights”, particularly for the vitamin d deficiency issues in this particular PBSP/CDCr patient population, will become obvious as I proceed.

I believe that the long term solitary confinement patients at PBSP SHU are subject to excess exposure to ionizing radiation. During my time at PBSP, custody would at times bring patients or groups of patients, usually from the SHU or from administrative segregation, to the x-ray facility in the infirmary to get abdominal x-rays to look for sequestered contraband. Supported by my then boss, the medical staff developed the posture that no x-rays would be done for custody convenience. We needed a medical indication to expose patients to ionizing radiation. This was a new posture on the part of the medical side of the prison. This was appropriate and supportable push back from medical that usually does not happen. Medical understood that there was a lack of adequate staffing on the part of custody to be able to “potty watch” these patients over perhaps days to catch contraband in their stools, but that was more of a custody staffing issue than a medical issue and many issues similar to this that can cause conflict between medical and custody can be ameliorated with more custody support staff….a difficult task in the current economic and political environment. So, from that point forward there was no more custody “at will” irradiation of patients for non-medical purposes. Custody may be able to make staff safety argument in part here to support their side of this argument, but this is where this policy stood for some years until recently. Now, custody from PBSP has managed to obtain a court order from a local judge to have patients x-rayed per custody’s request. There was no adequate pushback from the current medical management, and they decided to acquiesce to custody.

Just in the past week we have two disturbing medical reports that demonstrate the effect of cumulative medical x-ray exposure in patients. The first is the report describing a 3 fold increase in both brain cancers and blood cancers in children up to age 22 that correlates to the number of head cat scans that they have had. The other is the detailing of increases in breast cancer in women that correlates to the number and amount of diagnostic radiological studies. Physicians and radiologists are scrambling to adapt to these data.

What this means for long term solitary confinement patients is that there may be increased risk for x-ray related injury and illness the longer they are in solitary and exposed to this kind of policy. It is unclear to me, whether or not this same thing happens at CDCr facilities other than PBSP, happens in prison and jail facilities in other states or happens in federal prison and in immigration detention facilities. This is a kind of medical embellishment to torture that I spoke of earlier.

There are physicians who treat patients in solitary confinement who are medically punitive to that group of patients because these doctors judge these patients in their own heads and hearts and consciously participate in putting them down. At a minimum, they intentionally undertreat these solitary confinement patients deemed to be ”the worst of the worst”

When I first arrived at PBSP, there was a specific physician who i found out surveilled all of my orders for medical care that I wrote for patients in the SHU. He would go behind my back and without my knowledge to discontinue my orders for specific medical care if he felt that the particular patient was “undeserving” or if he severely personally disliked the patient. Of course he had supporting elements on both the medical side of the staff and, I suppose, on the custody side of the staff to be able to get away with this practice starting from before I came to PBSP. He was alleged to have prescribed a psychotropic medication to a SHU patient who was not a mental health patient, just to “dose” him. This very toxic physician, with whom I did much battle, eventually was allowed to resign under fire. He had done a number of other dangerous offenses for which he was caught and investigated. Those actions involved SHU patients and non-SHU patients that he treated.

It turns out that that particular doctor was only a prequel to the current medical manager. The current medical manager at PBSP was my last medical boss at PBSP. He and I locked horns soon after his arrival in January of 2005. In March of 2009, i was a main witness against this medical manager who was found guilty of “cruel and unusual punishment” and “breach of contract” to a long term solitary confinement patient who I had been treating around the issues leading to this case. Essentially, this patient had won a prior federal case ruling against PBSP/CDCr for a very detailed medical care contract. My boss wanted to rescind that contract for no good reason. I argued vehemently with him and with his boss not to do this. My boss transferred me out of the SHU and discontinued and downgraded this patient’s medical care to the point where the care was out of compliance with the formal medical contract. The patient sued, subpoenaed me as a witness, and easily won this preventable case in federal court. Apparently, the PBSP/CDCr, which is under federal receivership because of the CDCr patient’s successful lawsuits for “cruel and unusual punishment”, has no problem with allowing this same doctor to continue to be the functional top-level medical manager at PBSP in their employ.

This same medical manager is my chief adversary in almost all of these medical habeas corpus cases out of the SHU at PBSP in local court, where he has discontinued medical care or did not allow the PBSP doctors to prescribe adequate medical care. That is what these cases are about. I have spoken earlier about the good physicians wanting to practice good defensible medicine, but having to navigate poor work conditions and negotiate with a management structure that is controlled by this particular overbearing medical manager who has demonstrated deliberate indifference to medical need in a court of law. There is very deep trail of evidence pertaining to the patient punitive attitudes and actions of this administrator that apparently has not penetrated the upper levels of medical management in the CDCr medical receiver’s office, penetrated the federal court of the honorable Thelton Henderson, penetrated adequately to the California medical board, penetrated to the prison law offices or penetrated to the California department of health services, the medical licensing agency for PBSP’s medical infirmary now called a correctional treatment center (CTC).

In this country, there is emerging a large amount of evidence that people are sent to prison innocently for a variety of reasons. We have the ever increasing number of individuals who have been wrongly convicted and taken off of death row. We have New York and Los Angeles police departments and others admitting to framing a large number of mostly men of color in various schemes. We have cases of people that died in prison from medical neglect and medical malfeasance then were found to be innocent after death. We have the shameful justice catastrophe of the town of Tulia, Texas. We have Sister Helen Prejean’s book that describes mostly prosecutorial misconduct in the execution of innocent people. We have the inefficiency and near collapse of the public defender system, and it’s contribution to wrongful convictions of the poor that are ultimately overturned.

When some of the younger particularly Hispanic males enter PBSP, it is very difficult for them to not affiliate with what appears to be a “protective gang”. Even if they were innocent when they came in, what happens to them after they enter the prison environment is difficult to witness. I am not saying that all patients who end up in PBSP in the SHU are totally innocent. I am saying that i am not willing to make that call one way or another. The job of the medical care providers should never involve that kind of consideration. They should be patients to us. The medical staff is only in prison because human beings become ill and diseased, not because they commit crimes. But, I find that such considerations are not always the primary medical directive that is operative in that negatively enhancing environment.

The statements here are only a small part and the most recent part of a much larger document that i have created that examines my experiences with medical issues in the correctional setting. My specific experiences have been in the setting of PBSP. It is hard to believe that these problems only exist in this way at this institution in an isolated fashion. But, i have come to believe, as stated earlier, that long term isolation in prison on its own, serves no useful, demonstrable purpose and introduces a myriad of medical problems that complicate the issue as can be demonstrated here.

Long term solitary confinement is clearly, unnecessarily unhealthy for the patients, the staff, and is unjustifiable in this civilized society.

9 thoughts on “Letter from a Doctor”

Reblogged this on Wobbly Warrior's Blog and commented:
” … from what I have witnessed, is torture. The prison system embellishes and enhances that torture. Long term solitary confinement should be attenuated then abolished in the jails and prisons of the United States of America.”

Very disturbing indictment of the medical system at Pelican Bay.I believe it.
I am a medical care giver myself.Have worked in critical care for over thirty years.
Cruel people like those whom Dr Allen described do exist in the medical profession;given the circumstances and situation at Pelican Bay;these people would torture prisoners without a trace of conscience.
Being a nationalist from Belfast,Ireland;I “grew up” with men who were prematurely gray and sickly from hunger strikes.hunger strikes became part of our culture;so I am in solidarity with anyone who decides on the ultimate sacrifice;be they in Palestine or in Pelican Bay.
Leo Sacramento

I am absolutely touched by your honesty and compassion for human life, as should be as a medical provider and fellow human being.
I applaud you for standing up for what is right.
Medical professionals should not ever be judgmental. Neither should correctional staff. At minimum do your jobs. Medical post ions are to “”care” for their patients. Custody staff should also not sit in “judgement” as that is not their position or right either.
It us very clear to me that the system is broken and continuing to “break people” not prevent crime.
My heart goes out to these human beings and again I do applaud you for bring light to this ongoing decades long treatment. It is torture!

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